ABSTRACT
Records from 653 patients treated between 1991 and 1998 in the Oncology Practice Patterns Study (OPPS) were analyzed to determine contemporary chemotherapy delivery patterns in patients with intermediate-grade non-Hodgkin's lymphoma (NHL). Of the 653 patient records reviewed, 90 (14%) omitted an anthracycline or mitoxantrone (Novantrone) from primary therapy. Among patients receiving CHOP (cyclophosphamide [Cytoxan, Neosar], doxorubicin HCl, vincristine [Oncovin], prednisone) or CNOP (cyclophosphamide, mitoxantrone, vincristine, prednisone), 134 (27%) of 492 received an average relative dose intensity of less than 80% of the literature-referenced dose, due either to an inadequate planned or delivered dose. Of 181 advanced-stage patients with responsive disease, 28 (15%) failed to receive at least six treatment cycles. Overall, 283 (43%) of 653 patients potentially received suboptimal chemotherapy due either to choice of regimen or chemotherapy delivered. Patient age > or = 65 years and cardiac comorbidity appeared to have the greatest influence on a physician's decision regarding chemotherapy administration. Among the 492 patients who received CHOP or CNOP, 235 (48%) experienced a delay or reduction in chemotherapy dose (usually neutropenia-related), 100 (20%) developed mucositis, and 116 (24%) were hospitalized for febrile neutropenia. Growth factor was administered to 261 patients (53%), and its primary prophylactic use was associated with a significant reduction in the incidence of hospitalizations for febrile neutropenia in all patient subgroups receiving appropriate chemotherapeutic dose intensity (P = .02). This assessment of chemotherapy delivery to patients with intermediate-grade NHL showed significant variation from current standards. Further analysis of factors influencing chemotherapy delivery might improve therapeutic outcomes.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Lymphoma, Non-Hodgkin/drug therapy , Adolescent , Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Cyclophosphamide/administration & dosage , Cyclophosphamide/adverse effects , Disease-Free Survival , Dose-Response Relationship, Drug , Doxorubicin/administration & dosage , Doxorubicin/adverse effects , Female , Growth Substances/therapeutic use , Humans , L-Lactate Dehydrogenase/analysis , Lymphoma, Non-Hodgkin/enzymology , Male , Middle Aged , Mitoxantrone/administration & dosage , Mitoxantrone/adverse effects , Neutropenia/chemically induced , Prednisolone/administration & dosage , Prednisolone/adverse effects , Prednisone/administration & dosage , Prednisone/adverse effects , Reference Values , Retrospective Studies , Severity of Illness Index , Time Factors , Vincristine/administration & dosage , Vincristine/adverse effectsSubject(s)
Agranulocytosis/chemically induced , Anthracenes/adverse effects , Maprotiline/adverse effects , Neutropenia/chemically induced , Depression/drug therapy , Escherichia coli/isolation & purification , Female , Humans , Leukocyte Count , Middle Aged , Pharyngitis/diagnosis , Urinary Tract Infections/diagnosis , Urinary Tract Infections/microbiologyABSTRACT
Three patients with Hodgkin disease, eight with non-Hodgkin lymphoma, and one with chronic lymphocytic leukemia refractory to conventional combination chemotherapy were treated for remission induction with a new kinetically designed four-drug combination consisting of bleomycin, vincristine, adriamycin, and prednisone and given the acronym "BOAP." Eight patients had prior radiotherapy, included two who had total nodal irradiation. Eight patients (all three with Hodgkin disease and five of eight with non-Hodgkin lymphoma) achieved complete remission (73% of the lymphoma patients). An additional two patients with non-Hodgkin lymphoma sustained partial remissions, for an overall response rate of 91%. Toxicity caused the interruption of therapy in three patients and an additional patient might have sustained a drug-related death. This study compares favorably with other studies investigating primary or secondary combination chemotherapy of advanced lymphomas.
